MEDICARE: THEIS CHIROPRACTIC CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	1826	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285812602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEIS CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	6525 MARKET AVE N
Second Line	:	SUITE 101
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-433-9000
Fax Number	:	330-433-9026

Provider Business Practice Location Address
First Line	:	6525 MARKET AVE N
Second Line	:	SUITE 101
City	:	CANTON
State	:	OH
Zip	:	44721-2430
Country	:	US
Telephone Number	:	330-433-9000
Fax Number	:	330-433-9026

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	DR. KARL DAVID THEIS
Credential	:	D.C.
Telephone Number	:	330-433-9000

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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